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. 2025 Aug;44(8):1307-1318.
doi: 10.1016/j.healun.2025.03.019. Epub 2025 Apr 1.

The United Kingdom's experience of controlled donation after circulatory death direct procurement of lungs with concomitant abdominal normothermic regional perfusion with an analysis of short-term outcomes

Luke John Lloyd Williams  1 , Rachel Hogg  2 , Miguel Angel Reyes Roque  2 , Sarah Beale  2 , Mubassher Husain  3 , Anand Jothidasan  3 , Bart Zych  3 , Vicky Gerovasili  3 , Pradeep Kaul  4 , Steven Tsui  4 , Hassiba Smail  4 , Ahmed Al Adhami  4 , Jasvir Parmar  5 , Stephen Pettit  4 , Sri Aurovind Periasamy  4 , Prashant Mohite  4 , Philip Curry  6 , Simon Messer  6 , Karim Morcos  6 , Rajamiyer Venkateswaran  7 , Vipin Mehta  7 , Vamsidhar Dronavalli  8 , B C Ramesh  8 , Aaron Ranasinghe  9 , David Quinn  10 , Binu Raj  3 , Ruth Sutcliffe  7 , Dharmic Suresh  7 , Chris Johnston  11 , Gavin Pettigrew  12 , Andrew Butler  12 , Anne Olland  13 , Gillian Hardman  8 , Christopher Watson  14 , Derek Manas  15 , Ian Currie  16 , Marius Berman  17
Affiliations

The United Kingdom's experience of controlled donation after circulatory death direct procurement of lungs with concomitant abdominal normothermic regional perfusion with an analysis of short-term outcomes

Luke John Lloyd Williams et al. J Heart Lung Transplant. 2025 Aug.

Abstract

Background: Abdominal Normothermic Regional Perfusion (A-NRP) improves outcomes for transplanted abdominal organs from Donation after Circulatory Death (DCD) donors. Concerns have been raised about the effect of A-NRP on lungs procured during multi-organ donation. We present the UK experience of performing direct procurement (DRP) of lungs from DCD donors with A-NRP.

Methods: Retrospective analysis of all 487 UK DCD lung donors between April 1, 2011 and December 31, 2023. Organ transplantation rate and 30-day, 90-day and 1-year survival rates were compared between DRP of DCD lungs, DRP of DCD lungs with A-NRP and donation after brainstem death (DBD) lungs. Primary graft dysfunction (PGD) rates were compared between DCD lungs with and without A-NRP.

Results: Three hundred ninety-seven DCD donors resulted in a lung transplant (22 retrieved by DRP with A-NRP). There was no difference in lung transplantation rates between DRP and DRP with A-NRP. Of the 390 first adult-only lung transplants performed from DCD donors, there was no significant difference in 30-day, 90-day and 1-year survival between DRP of DCD lungs and DRP with A-NRP. There was a significant difference in survival between standard DCD donors and DBD donors at 30-days and 90-days, but not 1 year. There was no significant difference in grade 3 PGD rates at 72 hours post-implantation for DCD lungs with or without A-NRP.

Conclusion: In the UK experience, use of A-NRP is not detrimental to procurement of DCD lungs. We advocate the use of this technique until further studies can explore the safety and efficacy of thoraco-abdominal NRP for lungs in multi-organ retrieval.

Keywords: abdominal normothermic regional perfusion; donation after circulatory death; lung transplant; organ retrieval; primary graft dysfunction.

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